Pediatrician - Special Surgery Edition
October 9, 2015
Gabrielle Glanville was hardly shy about approaching people, even if others felt uncomfortable approaching her because of her weight, which was over 300 pounds. “People wouldn’t approach me but I was very friendly, I didn’t let it get the best of me,” says Glanville.
But the Maryland teen was worried about her increasing weight and related health problems like diabetes, hypertension and heart disease getting the best of her. Like many overweight and obese young people she tried everything from nutritionists to running clubs to lose weight only to see it return. She needed, she says, a remedy that would force her to lose weight, keep it off and stay healthy.
“I reached a point where I knew things had to change not because of how I looked but because of how I felt physically,” says Glanville. “My blood pressure and cholesterol were fine but I knew I’d have problems later on if I didn’t lose weight.”
That’s when Glanville, 16 at the time, learned about Johns Hopkins Center for Bariatric Surgery and bariatric surgeon Kimberley Steele, who offers weight loss surgery for adolescents. Criteria for teens, Steele explains, include a BMI over 35 with severe medical comorbidities, BMI over 40 with less-severe obesity related conditions, and a failed supervised six-month diet and exercise program. Pediatric patients, she adds, go through rigorous educational, nutritional and psychiatric evaluations, as well as anesthesia, medical and surgical consultations to help determine whether they are candidates for surgery. A strong supportive family environment is also a must.
The center offers such pediatric patients three surgical options, all laparoscopic—adjustable gastric band, vertical sleeve gastrectomy, and gastric bypass. The band and sleeve are so-called “restrictive” weight loss procedures in that they limit the amount of food patients can eat at any one time. In the sleeve approach, which Glanville opted for, three-quarters of the stomach is removed, reducing its typical watermelon size to that of a banana. Also, because there’s no cutting or rerouting of the small bowel, bile and pancreatic fluid allow food to be completely digested and absorbed in the bowel.
The results? The evidence is still scarce because bariatric surgery has only recently been offered to adolescents, Steele notes, and most long-term studies have focused on obese adults, with around 80 percent of patients losing and keeping weight off (Obesity Surgery 2006 Aug;16(8):1032-1040). To date there is one large longitudinal study tracking outcomes in adolescent patients for longer than a year (JAMA Pediatri. 2014;168(1):47-53).
“The nice thing about surgery is the weight loss is maintained and sustained,” says Steele. “Patients who stick with it, are compliant, see their primary care physician and follow nutritional guidelines following surgery do great.”
Glanville, now 125 pounds lighter and a freshman in college, agrees: “I’m very much more active now, feeling healthier and freer, like a weight has been lifted off of me.”
For more information, contact the Johns Hopkins Center for Bariatric Surgery at 410-550-0409 or email bariatric surgeon Kimberley Steele: firstname.lastname@example.org.